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A 66-year-old male presents to the emergency room as an unrestrained driver in a motor vehicle accident. While initially only complaining of mild neck pain, within 30 minutes of the collision he started to experience bilateral numbness in his hands and significant symmetric upper limb weakness. Soon thereafter, the weakness extended down to his lower extremities. Neurologic examination is remarkable for loss of pain and temperature sensation in his bilateral upper extremities and symmetric bilateral upper extremity greater than lower extremity weakness. Which of the following is the most likely diagnosis?
A 30-year-old male comes into the clinic with a 3-month history of scalp tenderness. His MRI brain is shown below (Left: T1, Middle: T2, Right: T1 with contrast). Which of the following is the most likely diagnosis?
Which of the following findings is depicted in the vessel imaging shown?
A 56-year-old man with idiopathic Parkinson’s disease presents to the emergency department for hypertensive emergency and tachycardia. You suspect that this may be an adverse effect related to one of his medications. Patients that are prescribed MAO-B Inhibitors should be counseled on avoiding which of the following?
Which of the following is the mechanism of action of prazosin?
According to Practice Parameters by the American Academy of Neurology, Which of the following is not recognized as a reliable assistive device in accurately predicting a poor outcome in comatose patients after cardiopulmonary resuscitation for cardiac arrest?
A 65-year-old female presents to the Emergency Room with a 2-month history of altered mental status and jerking. On examination, you appreciate an exaggerated startle response. Her MRI was shown below. Which of the following statements is true?
A 25-year-old female presents to the clinic with headaches for a year that occur two to three times a month. The pain usually occurs on one side and is associated with nausea and light and sound sensitivity. During these episodes, she is unable to go to work. Over-the-counter anti-inflammatories are ineffective. Physical exam and vitals are normal. Which therapy is the most appropriate next option in treatment?
A 16-year-old girl with no significant past medical history presents to the clinic with 2 episodes of syncope in the past month. She states that both of the episodes occurred while giving oral presentations in front of her class. She reports that she has been under a lot of stress lately because of a midterm paper and that her parents are going through a divorce, which has taken an emotional toll on her. Before each episode of syncope, she feels warm and starts to get lightheaded, and “sees stars”. Each episode of syncope lasts approximately 15 seconds, and she does not have any confusion after the episodes. The physical exam is within normal limits. Which of the following is the most likely cause of this patient’s syncope?
Which of the following is the mechanism of action of tolcapone?
A 37-year-old woman with a history of chronic alcoholism and amphetamine abuse presents to the ED with a 36-hour history of recurrent hematemesis and abdominal pain. She had no detectible ethanol levels in her blood on arrival. In the ED she complains of double vision and is started on intravenous fluid replacement. Two hours later the patient begins to develop ataxia and becomes progressively disoriented. The patient’s rapid deterioration is most likely due to which condition?
A 16-year-old male is brought to the emergency room by his parents for generalized weakness. The patient states that he woke up in the morning that day with flaccid paralysis of his arms and legs which was so significant that he couldn’t get out of bed. In typical teenage boy fashion, he wasn’t very worried about this at the time and went back to bed. It wasn’t until 4 hours later when he woke up again with the same degree of weakness that he became concerned and screamed for his parents to help. The patient denies any recent drug or alcohol use. The only interesting thing from the previous night was that he partook in and won a pizza-eating contest with his friends. The patient’s father admits to having had similar episodes to this when he was younger. If the patient’s symptoms are due to a genetic disorder, a mutation in which of the following genes is most likely responsible?
A previously healthy 25-year-old female presents to the emergency room with lower extremity weakness, numbness, and urinary retention. Lower extremity hyperreflexia and a sensory level at T10 were appreciated on examination. A contrasted cervical/thoracic and lumbar MRI was performed and shown below. Lumbar puncture was performed after imaging was completed and showed an elevated protein concentration, normal glucose, 3 WBCs, and oligoclonal bands. Rheumatologic studies are negative. Based on the most likely diagnosis, what is the most appropriate next step in medical management?
Socially inappropriate behavior, disinhibition, echopraxia, and utilization behavior are typically seen in which of the following?
A 24-year-old female with a past medical history of major depressive disorder with her last major depressive episode 6 months ago is brought to the emergency room by her boyfriend because of unusual behavior. For the past 4 weeks, the patient has had bizarre delusions, auditory hallucinations, and disorganized speech. She believes that her boyfriend is having a sexual relationship with a character from one of the early morning soap operas on television. Outside of her psychiatric symptoms, her neurologic examination is normal. Which of the following is the most likely diagnosis?
A 14-year-old female presents to the clinic with frequent falls, clumsiness, and stumbling on her feet. She also reports progressive difficulty with simple tasks such as buttoning her shirts and a loss of feeling in her feet. On physical exam, she has high-arched feet and loss of position and vibration sensation of her great toe. Thoracolumbar MRI shows atrophy of the cervical cord. This condition is associated with which genetic mutation?
A 66-year-old female comes to the EMG lab with the chief complaint of muscle cramps in the right lower extremity. She started having symptoms after treatment with a cholesterol-lowering medication but despite discontinuing the medication her symptoms persisted. Reflexes are 2+ in upper and lower extremities, except 1+ in the right Achilles. Nerve conduction studies of both lower extremities were normal. An EMG was performed and shown below. What is the most likely diagnosis?
A three-month-old female born full-term and without any significant past medical history is brought to the clinic with episodes of head-nodding for the past one week. Episodes last for only a few seconds and only occur while awake. On physical exam, there is an abnormal head tilt to the left and intermittent head nodding. Intermittent, horizontal, and bilateral nystagmus was also appreciated. Routine EEG and MRI of the brain with and without contrast were normal. Which of the following is the most likely diagnosis?
A 31-year-old female with depression, anxiety, and migraines presents to the ED for altered mentation. On arrival, she has a temperature of 41 degrees Celcius, HR 130, and a systolic blood pressure of 190. On exam, she is diaphoretic and agitated, with increased tone, hyperreflexia, shivering, and dilated pupils.
You call her family who states that the patient has a hard time keeping down a job, frequently moving from state to state. She has had a number of different psychiatrists over the years, and you, therefore, are unable to find a comprehensive medication list. In her purse, she has a pill bottle of sertraline, with 85/90 pills remaining.
Which of the following other medications is this patient likely taking?
A 47-year-old female presents to the clinic with the chief complaint of slowly progressive proximal muscle weakness. Electromyography showed short duration, low amplitude motor unit action potentials. A muscle biopsy was performed and shown below. A diagnosis is made and the patient is started on a therapeutic agent. What is the most likely medication initiated?